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Position Name : Prior Authorization Coordinator
Job ID : c5ac19501c8984f7
Description : Location: Remote Remote Location: # of openings: 1 Department: Employment duration: Full time Exemption Status: Non-Exempt Relocation Assistance: N/A Added to system: 1/27/22 12:09 PM Job Code: 430.220127.7645
Prior Authorization Coordinator I, II, III
MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!
Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.
At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!
Works as a member of the Prior Authorization Operations team. Processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments. Uses various business applications (MedAccess, FileNet, RightFax, etc.) to perform analysis, obtain information, and enter prior authorization data necessary for claims adjudication. Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based upon clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.). Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform the functions of the job. Extent of supervision ranges from close, to moderate, to minimal oversight based upon demonstrated skill and performance levels as defined for the position. This position is part of a three level career path with progression opportunities described in the Core Processing Career Path/Succession Planning Guidelines.
What You Get To Do:
Process and finalize PA requests within clients’ turnaround time (TAT) and Performance Guarantees (PGs) utilizing guidelines
Enter prior authorizations (Pas) into the system and prioritize requests
Check formulary alternatives, review tried and failed medications
Utilize drug references and verify the drug being requested is indicated and approved for the condition
Document all related information regarding the PA approval or non-approval
Respond to requests by faxing status of the PA to the physician or pharmacy
Conforms to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision making
Partners with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing
Accountable to achieve prior authorization processing productivity and accuracy standards
Analyzes, researches, and resolves prior authorization processing issues as appropriate for experience and career path level, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from team subject matter experts (SME) or supervisor; and referring unique or high dollar requests to supervisor according to guidelines
Coordinates notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations
Documents prior authorization related information and status
Makes outbound calls to obtain information and answer questions about prior authorization status
Collaborates with MCO and Self-Insured client teams to understand PBM clients’ prior authorization processing requirements and expectations
As appropriate for experience and career path level, partners with client teams to complete special prior authorization processing projects and provide accurate, timely, and reliable information to client claim inquiries
Collaborates with Contact Center Services in resolving prior authorization inquiries and handling incoming calls during periods of high volume
Protects and maintains confidentiality and privacy of all prior authorization and member information, including following strict protocols for date stamping and storage/security of prior authorization forms and related information
Level II – Process PA requests for complex plans, become a subject matter expert and begin mentoring new PACs, demonstrate flexibility and teamwork in covering all needed shifts
Level III – Accountable for QA of others’ work and make recommendations for RTL, coaching and training, handle complex research issues, assist with managing the workload by running/creating reports, provide task instructions and monitoring priorities, act as lead covering all shifts including weekend rotations, attend client meetings and act as a subject matter expert in process improvement and system enhancement activities
Education and/or Experience
For consideration candidates will need an Associate’s degree (A.A.) or equivalent from two year College or technical school
And one (1) year related experience and/or training
Or equivalent combination of education and experience
Level I: one (1) to two (2) years of Healthcare organization, retail or mail order pharmacy, or PBM experience preferred
Level II: three (3) to five (5) years of Healthcare organization, retail or mail order pharmacy, or PBM experience required
Level III: six (6) years or more of Healthcare organization, retail or mail order pharmacy, or PBM experience required
Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs
Experience with Windows based database programs is also required
Certificates, Licenses, Registrations
Must successfully complete one of the national certification exams OR obtain state licensure (in an U.S. State or Territory)
Maintains a current Pharmacy Technician License and/or CPhT certification without restriction
Other Skills and Abilities
Demonstrates ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment
Understanding of managed pharmacy benefit concepts including formularies, prior authorizations, edits, and claim adjudication
Working knowledge of customer service in a retail/outpatient pharmacy environment
Familiarity with pharmacy software data submission requirements
Self-starter with the ability to work independently and as part of a team that includes clinical pharmacists and other PACs
Attention to detail with a high degree of accuracy
Ability to prioritize and multi-task when presented with multiple duties
This position does not require travel, however attendance maybe required at various local training sessions and/or meetings.
Medical / Dental / Vision / Wellness Programs
Paid Time Off / Company Paid Holidays
401K with Company match
Life and Disability Insurance
Employee Referral Bonus
This position is eligible for Employee Referral Bonus at Level I
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers
MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.
To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
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[New Job Opening] Prior Authorization Coordinator job Vacancy in Remote
Are you looking for a Job in Healthcare Field then this post may be relevant to you.